This grant proposal is submitted by the University of Colorado on behalf of a consortium of 22 of the 36 known hospital Tumor Boards in Colorado's 55 hospitals. This represents hospitals ranging in size from 32 to 564 licensed beds located in metropolitan Denver (15 hospitals) and in 7 other communities throughout the State. Their combined reported cancer diagnoses in 1984 was over 10,000. The long-term objective of this grant proposal is to increase the effectiveness of tumor conferences (boards) in contributing both to decision making in cancer patient management and to the continuing education of a broad variety of primary care physicians, nurses, and allied health professionals, in addition to oncologic specialists. Specific aims include 1) the baseline evaluation of the process, impact, and outcomes of tumor boards as they now exist in regional hospitals varying widely in size, types of physician staffing, and cancer treatment capabilities; 2) the random assignment of half the Tumor Boards, after pairing by certain characteristics, to receive an education package for a one year period with close monitoring of process, immediate impact, and outcome as they relate to physician behavior, attitudes, and case outcomes, within the time frame available; 3) a crossover of this intervention to the remaining tumor boards for an additional one year period while observing the rate of change in the first subset following withdrawal of the education package; 4) the detailed analysis of data for a final six month period; and 5) preparation and submission of a set of recommendations to the NCI for increasing the educational and decision making potential of tumor boards in general. Methodology includes the use of relatively brief questionnaires to be completed by all tumor board attendees during the course of the session; recording of the attendance and descriptions of attendees; descriptions of the outcomes of each tumor board meeting by the Tumor Board Director; assessment of practice patterns through chart reviews, questionnaires and physician interviews, in relation to a standard such as the National Cancer Institute's PDQ; sampling of non-presented cancer patients from the collaborating hospitals and physicians' offices for comparison; and a detailed statistical analysis of these data.